OBJECTIVE: This systematic review and meta-analysis examined the efficacy of pain neuroscience education (PNE) on pain, sleep parameters, and psychosocial factors in chronic musculoskeletal pain conditions in adults and adolescents.
METHODS: The review was conducted in accordance with the PRISMA guidelines. A systematic search was performed using the databases Medline (PubMed), Scopus, PEDro, and Web of Science. The qualitative assessment was done by using the Physiotherapy Evidence Database (PEDro) scale and the Cochrane Risk of Bias (ROB 2.0) tool. The quantitative analysis was performed using RevMan 5.4.1 using a random-effects model, an standarized mean diffeerence (SMD) with 95% confidence intervals (CIs), and the certainty of evidence was evaluated using GRADEpro/GDT.
RESULTS: Twelve randomized-controlled trials (n=1485) met the inclusion criteria. The meta-analysis showed a statistically significant effect in favor of PNE on reducing pain intensity (SMD: -0.27 [95% CI: -0.5 to 0.00; I2 =67%]) and total sleep time with a small to medium effect size (SMD: 0.42 [95% CI: 0.12-0.71; I2 =0%]). However, no statistically significant differences were observed for other sleep parameters and psychosocial outcomes, despite some outcomes indicating a moderate clinical effect.
DISCUSSION: The findings suggest that PNE alone can reduce pain intensity, but greater improvements in sleep and psychosocial outcomes are seen when it is combined with interventions such as cognitive-behavioral therapy (CBT) and therapeutic exercises. These results highlight the potential role of PNE within a multimodal approach to pain management, while also underscoring the need for further research on its impact on sleep parameters in a specific population.
| Discipline Area | Score |
|---|---|
| Psychologist |  |
| Physician |  |
Physician rater
Pain neuroscience education (PNE) aims to help individuals reconceptualize their pain beliefs and behaviors by increasing their understanding of pain’s neurobiological and psychosocial mechanisms. As a pain physician and psychotherapist, the results are what I would have expected. PNE, if integrated into multidisciplinary pain management strategies including cognitive behavioral therapies, can produce clinically relevant improvements in pain intensity and sleeping time in individuals with chronic (primary) musculoskeletal pain. The majority of the studies included patients with fibromyalgia syndrome.
Psychologist rater
As a clinical psychologist with a specialty in pain management, these results will be very useful. This study provides me with advice for my colleagues, students, and clients.
Psychologist rater
It is interesting that simultaneous utilization of multiple forms of interventions was necessary and helpful, raising further questions regarding what works for whom, when, and toward what ends for study.
Psychologist rater
This is a solid review that clarifies that PNE should probably be used in clinical practice. The findings also suggest that PNE may be more comprhensively effective when embedded within multimodal interventions, particularly CBT and therapeutic exercise, than when delivered in isolation. The key next step is not simply to establish whether PNE works, but to identify its active ingredients and optimise its delivery (i.e., number and duration of sessions, total treatment length, format and combination with other interventions). Cultural adaptation also warrants particular attention because cultural differences may influence response, while educational level and health literacy could meaningfully moderate effectiveness.
, McMaster University